Double Dog Ranch

Lorinda Gayl / Sam Sevier

416 South Francisca Avenue

Redondo Beach, CA 90277

310-316-1133

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Double Dog Ranch Customer Input Form

Last Name

First Name

Address 1

Address 2

City

State

Zip

Home Phone

Business Phone

Cell Phone

Pager

E-mail address

Local Emergency Contact

Veterinarian Name and Phone

Animal Health Insurance

Yes No

Dog Evaluation Questionnaire

1- How often has your dog visited a dog park?

Dogs have parks?

Once or twice

Weekly

My dog has a reserved parking place

2- Was your dog ever agressive toward other dogs in the park?

Yes

No

3- Were other dogs ever aggressive toward your dog?

Yes

No

4- If yes to 2 or 3 what were the circumstances? Were there any injuries? Please explain.

5- Has your dog attended doggie day care? How frequently? Any problems?

6- If your dog has been left overnight it was at: (check all that apply)

Own home

Vet's office or commercial kennel

Daycare facility

Friend's house

Were there any behavioral problems either while you were away or upon your return? If so, what were they?

Does your dog try to dominate other dogs, in play or otherwise?

Yes

No

Is your dog submissive, rolling over on its back a lot when playing or otherwise?

Yes

No

In your opinion what would provoke your dog to bite another dog?

Is your dog toy possessive (not sharing toys with other dogs)? If so, what would she/he do if another dog wants to play with the toy?

When you leave your dog at home or anywhere else he/she:

Doesn't notice you're gone

Seems a little anxious at first but then settles down right away

Doesn't eat or relax but otherwise behaves normally

Keeps one eye on the door for any chance to escape and track you down.

Has your dog ever run away for any reason whatsoever (chasing cat, dog, looking for you, etc.)? If so, how many times, and in your opinion, what was the reason?

How does your dog behave around adult strangers?

Has your dog been exposed to (check all that apply)

Babies and toddlers

Small children

Adolescents

Any problems at day care? Please explain

How does your dog generally behave around other dogs?

Loves dogs, loves to play

Seems happy enough, never a problem

Only becomes aggressive if other dog does first

Would rather have one for breakfast

Does his/her behavior depend on the size, breed or gender of other dogs? Please explain.

When walking on leash and you encounter nother dog, your dog:

Continues walking, completely ignoring the other dog.

Strains at the leash to greet the other dog and exchange pleasantries

Strains at the leash to inflict grievous bodily harm upon the other dog.

My dog has never been walked on a leash

When given the "come" command, your dog

always comes, no matter what she/he is doing

eventually comes, but only after you've yelled yourself hoarse

occasionally wanders over to the vicinity of where you're standing

exibits "sudden deaf syndrome"

Has your dog ever bitten anyone including you? What in your opinion was the reason?

In our opinion what would provoke your dog to bite someone?

Under what circumstances does your dog bark?

What kind of shape is your dog in?

My dog rules in Iron Dog competitions

She/he runs or plays hard every day

Occasionally plays, runs or walks

Has attained slug status

Dog Information Form

Owner Name

Dog Name

Breed

Description / Color

DOB / Age

Licensed

Yes No

Spayed / Neutered

Yes No

Tattoo / MicroChip Details

Flea & Tick Program (both required)

Yes No

Feeding / Medication Instructions

Food Brand / Type

Pet Habits / Idiosyncrasies / Allergies / Additional Information

Should you have more than one dog please revisit this page and send the Dog Information section as many times as you need.

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